天津医科大学内科学课件 PEPTIC ULCER.pptVIP

PEPTIC ULCER Gastrointestinal Department, General Hospital,Tianjin Medical University Jiang Kui Hp increasing ulcer risk Therapy Chart 患者资料： 男；40岁 主诉：上腹部痛3月 检查：球部前壁溃疡(A) ;HP阳性 诊断：十二指肠球部溃疡 治疗：波利特 10mg qd×28天；克拉霉素 0.5 bid×7天； 甲硝唑 0.8 bid×7天 随访：4周后复查胃镜，患者无不适主诉 复查：2周后十二指肠球部溃疡(H1)；4周后十二指 肠球部溃疡(S2) 患者资料：女， 50岁 主诉：上腹痛， 返酸， 嗳气 检查：十二指肠球部多发性溃疡（对吻性溃疡） 诊断：十二指肠溃疡 治疗：波利特 10 mg qd×28 天 随访： ? 时间： 4周 ? 主诉：无 ? 检查：十二指肠球部溃疡（S1期） 患者资料：男；53岁 主诉：上腹及背部痛3月 检查：胃镜显示十二指肠球部前壁见约1.4cm憩室， 其黏膜充血糜烂，底部见白苔； 球部小弯侧见约0.5cm溃疡 诊断：十二指肠憩室伴溃疡 治疗：口服波利特 10mg qd×4 周 复查：胃镜示十二指肠球部前壁憩室，溃疡及炎症消失 Gastric ulcer first produces symptoms most commonly between 40 and 70 years of age ( peak occurrence at age 50 ). Gastric Ulcer ( GU ) GU patients generally have acid secretory rates that are normal or reduced compared with nonulcer subjects. Most evidence supports the primary importance of defective gastric mucosal resistance and / or direct gastric mucosal injury as most important elements in the pathogenesis of gastric ulcer. ETIOLOGY AND PATHOGENESIS Epigastric pain is the most common symptom . Pain may actually be precipitated by food, i.e., food-pain-relief. Recurrent gastric ulcer is less frequent than that of DU. Complications include: hemorrhage (10%-15%) , perforation (2%-5%), obstruction (2%-4%) canceration (1%). CLINICAL FEATURES The two major methods for diagnosis are barium examination and endoscopy. DIAGNOSIS Ulcer crater Table Differential diagnosis of benign and malignant gastric ulcer (I) benign malignant Age youth prime of life History long short Clinical feature epigastric pain periodical advanced development epigastrium mass no yes weight